Gaurav Bhardwaj1, Daini Ong1, Lyndell Lim1,2

Purpose: Syphilitic uveitis is a preventable cause of ocular and neurologic morbidity. In the setting of a current syphilis epidemic in Victoria, the aim of our study is to investigate the incidence of ocular syphilis presenting to a statewide tertiary referral service.

Methods: We performed a retrospective study of patients with syphilitic uveitis presenting to the Royal Victorian Eye and Ear Hospital (RVEEH) from January 2010 to January 2016. Information recorded included clinical examination findings, baseline BCVA, optical coherence tomography findings and post treatment BCVA.

Results: In 2015, there were 27,346 ophthalmic presentations to the RVEEH emergency department, of which 16 patients had a positive syphilis serology. Seven of these patients had uveitis related to active syphilis, equating to an incidence (of syphilitic uveitis) of 25.6 per 100,000 (95% CI 10.3-52.7). The rate of syphilis in 2015 was higher than in previous years studied.

All of these patients were males aged 20-56 (mean 39.7, SD 13.5), and in all cases, the ophthalmic manifestations were the first symptoms of the patient’s infection that prompted them to seek medical attention. OCT demonstrated a characteristic finding of loss of the photoreceptor layer along with bumps in the RPE. These findings resolved with treatment.

Conclusion: The incidence of ocular syphilis has increased during the study period, and correlates with the spike in new reported cases of syphilis in the general population. Ophthalmologists need to be aware of the increasing incidence of this old disease and have a high degree of suspicion.